MEDICARE: DISCOUNT PHARMACY & MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PHY43116	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0547995	OTHER	CA	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487653994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOUNT PHARMACY & MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	703 N FULTON ST
Second Line	:	SUITE 201
City	:	FRESNO
State	:	CA
Zip	:	93728-3405
Country	:	US
Telephone Number	:	559-268-0712
Fax Number	:	559-268-0722

Provider Business Practice Location Address
First Line	:	703 N FULTON ST
Second Line	:	SUITE 201
City	:	FRESNO
State	:	CA
Zip	:	93728-3405
Country	:	US
Telephone Number	:	559-268-0712
Fax Number	:	559-268-0722

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	MRS. VAN T NGUYEN
Credential	:	RPH.
Telephone Number	:	559-268-0712

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	03/04/2011

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